Executive summary. Clear communication and a documented follow-up plan reduce confusion while a coverage decision is still pending.
Definition
A prior-authorization delay is the period between a request for payer review and a final coverage decision.
Where this work lives in Attergo
Authorization coordinators work from the Attergo Authorizations Dashboard, Cases Queue, Case Workspace, Appeals Queue, Expiring Approvals, and SLA Board. Open or create the case, capture the payer decision and the supporting information, assign the next action, and update the case as it moves.
Patients often hear “not covered” when the real position is that a review is still open. Use plain language: the payer has asked for information, here is the next step, and the outcome is not yet known.
Review and follow up
Follow the prescriber’s directions and your organizational policy for urgent clinical questions. Keep contact attempts and payer updates on one record, so the patient does not have to explain their situation again to each person they reach.
Final decisions stay with the role your organization holds accountable for them. Record the decision on the item, with the evidence behind it, so the next person to open it does not start over.
Frequently asked questions
Who should use this Attergo workspace?
The role that owns the next action leads it: a billing specialist, an authorization coordinator, an inventory lead, a pharmacist, a compliance lead, or a finance reviewer. Access follows the role your organization assigns.
Referenced standards and further reading
- CMS: Interoperability and prior authorization ↗Centers for Medicare & Medicaid Services
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